BIG MEDICINE: WHOSE HEALTH ARE THEY PROTECTING? 327have to offer? We have pills and we have procedures. Right?" Esselstyn
leans forward and, with a slight grin, as if he's about to tell us the em-
peror has no clothes, he says, "But who ever says, 'Maybe we ought to stop
disease'?" In Dr. Esselstyn's experience, stopping disease does not figure
prominently into the status quo.LACK OF TRAINING
The medical status quo relies heavily on medication and surgery, at the
exclusion of nutrition and lifestyle. Doctors have virtually no training in
nutrition and how it relates to health. In 1985 the United States National
Research Council funded an expert panel report that investigated the
quantity and quality of nutrition education in U.s. medical schools.^4
The committee's findings were clear: "The committee concluded that
nutrition education programs in U.s. medical schools are largely inad-
equate to meet the present and future demands of the medical profes-
sion."4 But this finding was nothing new. The committee noted that
in 1961 the "American Medical Association Council on Foods and
Nutrition reported that nutrition in the U.S. medical schools received
'inadequate recognition, support and attention. '''4.5 In other words, over
forty years ago, the doctors themselves said that their nutrition training
was inadequate. Nothing had changed by 1985, and up to the present
time, articles continue to be written documenting the lack of nutrition
training in medical schools.^6 • 7
This situation is dangerous. Nutrition training of doctors is not merely
inadequate; it is practically nonexistent. In 1985, the National Research
Council report found that physicians receive, on average, only twenty-
one classroom hours (about two credits) of nutrition training during
their four years of medical schoo1.^4 The majority of the schools surveyed
actually taught less than twenty contact hours of nutrition, or one to
two credit hours. By comparison, an undergraduate nutrition major at
Cornell will receive twenty-five to forty credit hours of instruction, or
about 250-500 contact hours; registered dietitians will have more than
500 contact hours.
It gets worse. The bulk of these nutrition hours are taught in the first
year of medical school, as part of other basic science courses. Topics
covered in a basic biochemistry course may include nutrient metabo-
lism and/or biochemical reactions involving certain vitamins or miner-
als. In other words, nutrition is often not taught in relation to public health
problems, like obeSity, cancer, diabetes, etc. In conjunction with the 1985